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General NPI Number Information
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NPI Number | 1336423995
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Entity Type | Individual
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Provider Name | GORDON FRANK CVACH MSW
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Gender | Male
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Dates
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Enumeration Date | 09/30/2011
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 6348 W EMERALD ST
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City | BOISE
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State | ID
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Zip | 83704-8732
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Country | US
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Telephone | 208-302-0900
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Fax | 208-302-0955
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Provider Business Mailing Address
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Address Line | PO BOX 190930
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City | BOISE
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State | ID
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Zip | 83719-0930
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Country | US
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Telephone | 208-367-5170
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Fax | 208-367-5180
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6409-C
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4371852
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License Number State | ID
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